From the Archives: Spring 2009 Issue of Lupus Now
Q. The association between cancer and lupus has been recognized for years, but what do we know about the relationship of lupus to medications, to other environmental exposures including viral infections and tobacco, or to the interaction of these factors?
A. The role that each of these factors plays in the development of cancer in people with lupus has not yet been clearly elucidated. However, a group of international researchers under the able leadership of Sasha Bernatsky, M.D., has put together the largest cohort to date of people with lupus (nearly 10,000 participants), who have provided a total of more than 75,000 person-years of observation (average follow-up per participant, eight years). In this study the association of lupus and cancer—more precisely, of a type of lymphoma—was confirmed (42 cases). Whether the association was due to the disease itself, to medications, or to other exposures was not examined.
Subsequently, these 42 individuals were examined in detail and were found to have quite an aggressive form of lymphoma.
Recently, the collaborators investigated the contribution of exposure to specific medications and the occurrence of cancer in this international lupus cohort study. Age, Caucasian ethnicity, damage attributed to lupus, and use of tobacco were confirmed in predisposing the individuals to the occurrence of cancer.
In contrast, medications (immunosuppressants) were only an important risk factor for hematological (blood) cancers, and then only when a lag time of five years was considered (under the assumption that the effect of these medications could not be immediate).
Whereas the association has been clearly established between specific medications such as cyclophosphamide (Cytoxan®) and some tumors (bladder cancer) and can become evident in some people, for the most part lupus itself (damage being a proxy for its severity) and other well-known factors (tobacco exposure, older age) appear to be more relevant in persons with lupus.—Guillermo J. Pons-Estel, M.D., Jigna Mehta, M.P.H., and Graciela S. Alarcón, M.D., M.P.H.
Q. I know that Plaquenil® helps ease inflammation in the body, but does it lower the Westergren sed rate?
A. The Westergren Erythrocyte Sedi-mentation Rate (ESR, or SED rate) is a measure of how fast red blood cells (erythrocytes) fall in a test tube and may indicate (indirectly) some presence of generalized inflammatory proteins in the blood. However, the ESR can be elevated from many causes. It is not considered a particularly useful blood test or treatment target for lupus.
Plaquenil® has two known mechanisms of action that are relevant to lupus. One is that it is a mild inhibitor of activated blood fragments, called platelets, so it may help to protect against excessive blood clotting. The second is that it inhibits proteins called toll-like receptors, which may be involved in the hyperactive immune responses that occur in people with lupus.—Joan T. Merrill, M.D.
Q. I was told by someone who has lupus that noni juice is good for lupus. She says it keeps her blood counts up and more. I have lupus and bought the bottle but haven’t taken any yet; I’m kind of scared to. I thought maybe you have heard of this or maybe have some thoughts on it.
A. Over the past decade, noni juice has been used by some people for its potential anti-cancer and immune-stimulating effects. However, there isn’t any solid evidence that noni juice is beneficial for preventing or treating any specific medical condition. For someone with lupus, the potential effects of noni juice on the immune system could be harmful because lupus is an autoimmune disease, meaning the immune system is already overactive.
Moreover, the nutrient content of noni juice can be quite variable depending on the brand, and the potassium content can sometimes be quite high. If a person with lupus has kidney involvement, noni juice should probably be avoided, because kidneys that are not functioning properly may be unable to regulate potassium levels.
The bottom line is that there isn’t any clear evidence to suggest that noni juice is beneficial for people with lupus; if anything, it could be harmful. Before consuming noni juice, bring the bottle to your physician to review the nutrient content and discuss the potential effects of this substance on your condition. —Laura A. Coleman, Ph.D., R.D.
Guest Experts
STELLAR* Research Fellow Guillermo J. Pons-Estel, M.D., Lupus Research Manager Jigna Mehta, M.P.H., and Jane Knight Lowe Chair of Medicine in Rheumatology Graciela S. Alarcón, M.D., M.P.H., are at the University of Alabama at Birmingham. Dr. Alarcón is a member of the LFA Medical-Scientific Advisory Council.
*Supporting Training Efforts in Lupus for Latino American Rheumatologists (funded by Rheuminations, Inc.)
Joan T. Merrill, M.D., serves as LFA Medical Director and is head of the Clinical Pharmacology Research Program at Oklahoma Medical Research Foundation in Oklahoma City.
Laura A. Coleman, Ph.D., R.D., works at the Epidemiology Research Center of the Marshfield Clinic Research Foundation in Marshfield, WI. She is a long-time Lupus Now contributor and member of the magazine’s Advisory Board.